Orthopaedic Surgery- letting the cat out of the bag    **New**

This article will look into orthopaedic surgery and what happens before, during and after the procedure.

To assess whether a patient has an orthopaedic disorder, they are booked in with our orthopaedic veterinary surgeon. This is called a pre-op check, this includes a full general health check and a full examination of the orthopaedic disorder.

We offer various orthopaedic surgeries including:
•  Luxating Patella surgery – this is a disorder in cats and dogs which means their knee cap is unstable and luxates, this can be uncomfortable and is normally presented as lameness.
•  Cruciate surgery - our preferred method is TTA (Tibial Tuberosity Advancement) this is a procedure to correct torn/damaged cruciate ligaments in dogs. In smaller pets we would use the Lateral suture method.
•  Fracture repair - There are various methods to fix a fracture: external fixation is a variety of bolts, rods and plates on the outside of the leg to stabilise the fracture, if this is not the appropriate technique we have a variety of plates and screws.In younger animals we might use a cast or Robert Jones bandage, this is due to their constant growing.

Case Study:

Holmes Holmes came into our practice and presented with lateral recumbency, tachycardia (fast heart rate), vocalisation (which normally means they are in pain) and blood over his perineum(rear end). As Holmes is an outdoor cat it is assumed he had a fight with a car and lost!

Before Holmes was anaesthetised we performed a blood test to look for any damage we couldn't physically see on x-ray, for example, liver and kidney parameters and red blood cells. This indicated he had a low PCV (Pack cell volume) which meant he was anaemic. This meant the surgery had an increased risk and blood loss was a concern, our vets and nurses gave him the necessary medication and support to correct the anaemia before he was anaesthetised.

Before our veterinary surgeon can devise a plan we need to take x-rays to determine which surgery we need to perform. Firstly we draw up a pre-medication to make sure he's got pain relief on board before we have to move him to ensure we don't cause him additional discomfort, there's also a bit of sedation in the pre-medication to relieve any anxiety and fear and which also relaxes the muscles. After 10 minutes Holmes was then ready to be transferred into the x-ray room where we can take digital x-rays of his pelvis. He was calmly anaesthetised and our theatre nurse cuddled him during induction then held him in position so the vet could intubate him (introduce an endotracheal tube). Our nurses are fully trained in radiography and position/monitor all patients.

From the x-rays we can see that the left side of the pelvis is fractured and badly misplaced. Once confirmed, I then shaved the area the veterinary surgeon needed to make the incision, this involved clipping from mid spine to the base of his tail and mid femur to ensure the surgeon had a big surface area to operate. I then have to make sure the area is sterile, by making up some surgical scrub. We use hibiscrub diluted in warm water, I then added swabs. There's a specific technique we use as nurses to ensure sterility of the area. First we do a hashtag motion over the shaven area until visibly clean, then dampen down the hair around the edge. We then use chloraprep to finish the preparation, this is still the same technique as above (this does have an orange tint).

Once the area is clean I then moved him into theatre where the operation will take place. Theatre has to remain sterile, this means that there is only one door in and out to prevent nurses and staff coming through as this could bring in airborne contaminants which could then lead to an infection of the wound. Holmes is placed in sternal recumbency (on his belly) as the incision was made on his lower back over the pelvis area. The veterinary surgeon will place a waterproof drape over the patient first, to prevent strike through of water when used with the drill. Then four other medium plane drapes are placed over the top leaving a window area over the area of interest. Myself and the other assisting veterinary nurses open up multiple instruments during orthopaedic surgeries. Holmes Screw Once the procedure is completed the veterinary surgeon and nurses take postoperative x-rays to ensure the screw is in the correct place, once the veterinary surgeon is happy we wake the patient up. The most important thing when a patient is waking up from surgery is that they have a well padded kennel and to restrict movement to ensure no damage is caused to the healing wound.

Home care is also very important and we ensure clients comply with our post operative instructions such as, strict rest, bland diet for few days and post operative checks. Holmes's wound healed very well as seen in the photo. Holmes Healed Following surgery cat's are to be kept indoors and crate rested. On occasion dogs also need to be crate rested but generally cope well with short lead walks and strict rest in the house.